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Reilly Benefits, Inc. is pleased to announce that April S. Ewaski has joined the firm as an associate.

As a healthcare consultant Ms. Ewaski will be responsible for business development and will lead the agency’s expansion into the exchange-based programs scheduled to roll out in the fall of 2013.

“April fills a pivotal position for us at a time when healthcare reform is quickly creating new opportunities,” said David Reilly, President of the firm. “Her determination to succeed and eagerness to work with people makes her a perfect fit for this role.”

Ms. Ewaski is a graduate of University of Maryland, Baltimore campus. She resides in Annapolis, MD, where she teaches dance as a hobby and remains a member of a professional modern dance company.

September 23, 2012 marks the next important date for health plan sponsors under the rules of the Patient Protection and Affordable Care Act (PPACA). As of this date insurance companies are required to begin providing members a new notice known as a Summary of Benefits and Coverage (SBC).

The SBC is a document intended to provide health plan members a brief overview in plain language of what the insurance plan covers along with a uniform glossary of important terms. PPACA requires this notice to be no longer than four pages, front and back, be drafted in 12 font, and be provided in a culturally linguistic manner.

Health insurance companies are required to provide the notice to members enrolled in individual plans, but for employer plans the health insurance companies will provide the notice to the plan sponsor. It is then the responsibility of the plan sponsor to distribute the notice to its plan members pursuant to specific timelines prescribed by the Department of Health and Human Services.

Generally, the SBC must be distributed during the open enrollment process at renewal and also throughout the plan year for new members. The first notice must be provided beginning with the policy renewal date (effective date for new policies) on or after September 23, 2012.

Plan sponsors should be on the lookout for a communication from the health insurance company, and a strategy to distribute the notice should be incorporated into the administrative process. Your broker or consultant should guide you through the process.

Click here for an example of the notice, here for details and instructions as to how to develop the notice.

The Supreme Court will rule in less than 48 hours on the fate of Obama’s signature legislation, the Patient Protection and Affordable Care Act (PPACA).

This has been one of the most watched cases and most anticipated decisions in at least a generation. Arguably, not since Roe V. Wade has a case stirred so much emotion, so much controversy.

The U.S. Supreme Court is expected to release its landmark healthcare reform decision this Thursday, June 28, 2012.

Sure, the Court has heard plenty of important battles since that divisive decision forty years ago – death penalty, immigration, gays in the military, even the outcome of a presidential election. But none of these decisions could have been expected to directly touch every man, woman, and child in this country.

The Pundits and industry-watchers have debated and surmised the outcome for months. White papers, panelist presentations, debates, commentaries, protests, commercials, and the endless discussion across the 24-hour news cycle – none of it matters anymore. Nobody sways the outcome. And nobody knows the outcome, except for nine Justices who secretly decided the case many weeks ago.

We can only wait, and wait we have. But it’s almost over. This Thursday, 10am is decision day. And then we’ll know the outcome. We’ll know where we’re going, what health care in the country will look like, how it will touch each and every one of us, right? Don’t bet on it.

We seek clarity. Yes, we’ll have a decision. And it will be, decidedly, disappointing. Confusion! And, the campaigns will fill their war rooms. The lobbyists will schedule their appointments. The lawyers will start their research. The pundits will hit the air waves.

And you and I and our doctors will know less than we did on Wednesday. Welcome to Healthcare Reform, Round Two.

The market for pet Insurance has grown quite a bit over the last few years. Most who have the coverage purchase individually, but some employers have looked to add the option for employees to purchase on a group-rated, voluntary basis through their benefit programs.

Do you have pet insurance? What’s been your experience? Have you been pleased with the cost/benefit? We appreciate your comments and feedback.

You’ll be able to count your steps, distance traveled and calories burned for each workout with Ready, Step, Go!. Aim for 10,000 steps a day to help control your weight, reduce stress, strengthen your heart and lungs, and improve bone density. Just visit your favorite app store and search for Ready, Step, Go! It’s a free download for those who have an iPhone, iPod Touch or Droid smartphone.

Since it’s passage on march 23, 2010, public opinion about the Patient Protection and Affordable Care Act (PPACA) has remained deeply divided. For two years now we’ve been treated to an endless supply of polls that demonstrate the philosophical differences amoung Democrats and Republicans. It’s been great fodder for campaign commercials and weekend news shows. But what do the party polls really tell us – that Democrats and Republicans disagree? We should all be surprised!

The Henry J. Kaiser Family Foundation recently released an interesting tracking tool that looks at public opinion of PPACA in a more detailed, more interesting, way. This tracker looks at opinions and how they may or may not have changed for of a variety of groups since President Obama signed the legislation. The data demonstrates differences among party affiliation, but more importantly, it also demonstrates the differences among groups based upon age, gender, income, and even insurance status. While these results may not be so surprising either, the data certainly paints a better picture of how deeply divided the country remains over ObamaCare.

We’ve all seen the duck. He’s the quacky little fella who tells us to ask about AFLAC at work. But what is AFLAC? Why would we ask for it at work? And why should we listen to a duck?

The duck leads an advertising campaign created in 1999. The marketing has been so brilliant that today AFLAC is perhaps known more for the quacky character than it is for the insurance services it provides. In fact, the duck has been so successful that it even holds a place on Madison Avenue’s Walk of Fame as one of America’s Favorite Advertising Icons.

AFLAC insures members by offering cash benefits for a variety of events that create out of pocket expenses. Policies include, but are not limited to, accident, sickness, cancer and other specified health events, hospital confinement, disability and dental and vision. Each policy can be selected individually and are typically offered through employers who conveniently payroll deduct the monthly premiums. This is why we’re told to “ask about it at work.”

AFLAC policies are generally available without much in the way of medical underwriting and they do not require medical exams. Where an employer does not offer a benefit, for example dental or disability income protection, employees can purchase a policy based upon individual needs, regardless of whether other employees have the same needs. It’s truly a voluntary product.

One of the best uses of an AFLAC benefit can be found within the accident and sickness plans. With so many medical plans adopting high deductibles these days, cash benefits for injuries and illness compliment the health plan by providing dollars that can be used to help pay the deductible. This can be a great help to the many without savings or disposable dollars, particularly at time when stresses are likely high as a result of the injury or sickness.

With over 60 million members worldwide AFLAC, a Fortune 500 company, is one the largest insurance companies providing individual policies. There are many reasons for this success, including the wide variety of products, low cost, little paperwork, speedy claim turnaround, and yes, even the duck. If you don’t already have AFLAC, then you may want to “ask for it at work.” It’s worth it.

A broken arm recovers in three months but medical claims and billing will last much longer.

As insurance advisors we review medical claims for clients every day. Today my family has claims of our own.

A Saturday evening basketball game recently brought us to the emergency room after our 13 year-old took a bad spill and broke his arm on the court. Six hours, and the-still-yet-to-be-determined number of dollars later, we had our young man home adjusting to his newly fitted full-arm cast. Three weeks and a handful of x-rays later he’s doing just fine. That was the easy part.

Now we have to deal with the medical bills. Making sense of medical billing is difficult for most people. We have a $2400 family deductible, so we’re responsible for payments up to this amount before our insurance begins to pay. This means we’ll receive bills from many different providers for many different values for treatment rendered at several different points of service. We’ll see statements from the hospital for the emergency room, the office of the orthopedic surgeon, anesthesiology, radiology, pharmacy, and at least half a dozen follow up visits, many of these with even more radiology. We’ll even see a bill for the ambulance ride.

In addition to the mounds of bills from the various providers we’ll also receive explanations of benefits from the insurance company. Our insurance company calls these statements EOBs. Other carriers use the term explanation of coverage, or EOC. Explanations are provided to members to illustrate how the insurance company processes a claim. And the calculations can be confusing.

Understand the amount a doctor or facility charges isn’t normally the amount an insurance carrier agrees to pay for a particular service. Insurance plans usually have contracts with providers to pay lower pre-agreed upon rates. The EOB shows the provider’s actual charge, the fee reduction, the member’s responsibility, and the total amount the provider is allowed to collect from the member. Ideally the bill the doctor sends should match the member responsibility amount shown on the EOB. Members should always review and compare both the EOB and the doctor’s bill for consistency.

Unfortunately this isn’t always quite so simple. Often the carrier denies certain fees outright and explains the reason by listing an adjustment code. The adjustment code is usually found elsewhere in the EOB. For example, a claim may have been submitted by the doctor for a service that should have been charged as part of a different service. Think about a doctor’s office charging for an evaluation where the overall office visit should have included an evaluation. In this case the carrier would deny the duplicate fee and code the line item as such. A member may at first glance see only the denied fee and mistakenly believe a charge remains due. Only if the member carefully reviews the coding and member responsibility amount will it be determined the fee is unallowable. The member should then scrutinize the bill eventually received by the doctor to be sure the unallowable fee described by the EOB is waived.

Further complicating the EOB and billing process is that many plans only pay benefits (or pay higher benefits) when members seek services from network, or participating providers. Network providers have agreed to the fee schedule on which the carrier bases its payments. When a member seeks care from a non-participating provider the EOB will describe and code the charges as unallowable or reduced. In this case all or some of the charges are payable by the member and the doctor will send a bill. Still, even in this case the EOB will indicate the total member responsibility and the doctor’s bill should match.

Examples of other typical adjustments can include denials or reductions in coverage amounts for failure to obtain pre-authorizations or seeking care without proper referrals. There are many reasons for adjustments and all are coded and explained within EOB.

It’s been about three weeks since our youngster broke his arm. We’ll begin to see EOBs within the next week or so. Doctor and facility bills will begin to follow. Ultimately we’ll see dozens of EOBs and billing statements over the next couple of months for just this one event.

In our case, we’re responsible for the first $2400 in charges, the total of which accumulates as each EOB arrives. If we’re diligent, then we’ll maintain all records in a single place, and we’ll carefully match each EOB with each bill received. If we identify a mismatch we’ll contact the insurance carrier for further explanation. If it’s determined the insurance carrier made a calculation or coding error, then we’ll work to get that corrected. If we determine a provider’s bill to be incorrect, then we’ll contact the doctor’s office or facility to straighten it out.

Once we’ve satisfied our deductible requirement the EOBs will illustrate lower payment responsibilities in the form of copays and/or coinsurance. We’ll have to match these new amounts with future bills we receive, all the while maintaining the same careful review.

Billing is largely electronic these days, and members have a great deal of online access to view claims and provider payments. But the bureaucracy and number of providers involved, a general misunderstanding by members of the claims process, and the shear amount of paper in the form of EOBs and doctor bills remains a sure recipe for confusion. To simply pay bills and ignore the EOBs doesn’t allow a member to track the deductible, nor does it allow the member to verify the accuracy of payments to providers. Plan members should review and compare every EOB and every provider bill.

We know our young man will be back on the court in a couple of months, but we’ll still be thumbing through mounds of bills and EOBs, hoping to eventually put the confusion behind us…until the next time.

Businesses offer benefit programs as a means to attract and retain quality employees. Most offer medical, dental and vision policies. Others offer life insurance and disability income protection. Still, there are many low-cost ideas employers can embrace to enhance their programs. To truly offer competitive vs. comparable benefits employers can improve a program by including simple, value-added perks. As an introduction to this concept we reprint the following column with permission by its author, Kyle Lagunas, HR analyst at Software Advice.

Creative Benefits to Engage, Motivate, and Retain

Fact: A standard package of health, dental and vision insurance, some paid vacation, a modest life insurance policy is not “competitive.” Although attracting and retaining top talent continues to be a challenge for business leaders, most employers still boast of their competitive benefits offerings… which are really nothing special (“comparable,” even). And employers who continue to offer the same old benefits package will fall behind in attracting, motivating and retaining the best.

The lines between work and personal lives are blurring for many employees. They’re seeking balance between the two, and are finding value in the ability to choose the specific benefits that best meet their needs at this point in their lives. And employers are learning that, when chosen and implemented effectively, however, benefits can demonstrate leadership’s concern for the well-being of employees, reinforce cultural values, and foster deeper employee engagement.

According to James Berkeley, Director of Berkeley Burke International, however, there’s still a disconnect. “The decisions made regarding what benefits to offer are often based on subjective viewpoints, viewpoints that are far removed from the actual needs of employees.” Rather than assuming you know what your employees want, Berkeley suggests you ask them. Though answers will vary, many people are interested in more benefits in these areas:

Healthy Living and Wellness Benefits. Susan Combs, President of Combs & Company, “The biggest benefit that employees ask for is gym membership reimbursement.” Wellness programs like WalkingSpree–which creates walking clubs, assigns teams and creates competitions–are another great way to motivate and engage employees to live healthy (thereby reducing your health care costs).

Flexible Work Options. Telecommuting and other forms of flexible work options make employees healthier and happier. And as Sara Sutton Fell, Founder and CEO of FlexJobs points out, studies show that, “Employers who offer flexible schedules and alternatives to the traditional nine-to-five not only see higher productivity, but also save on health-related benefits they already offer.” Stanford University conducted a big study that showed that telecommuters were four percent more productive than office workers, working more hours and taking a larger workload.

Commuting Relief Benefits. More and more are looking for commuting relief benefits from their employers. Incentivize carpooling; use services like Transit Chek so employees can purchase transit tickets with pre-tax dollars; Or promote healthy living and alternative commuting options by installing bike racks your the office.

Perks You Can Afford. Great perks aren’t just for the guys in Silicon Valley. Many companies–big and small–bring in a massage therapist who offers chair massages to employees. Convenient and relaxing, this perk costs the employer nothing and might just keep employees in the office longer. Others adopt reward programs like BetterWorks where employees are given an allowance to spend on discounted food from local restaurants, dry cleaning, gym memberships and more.

Clearing The Great Leadership Hurdle

By offering benefits that are actually competitive, an organization can set itself above the competition–and build a strong culture of engagement and motivation. But as Eddie Trieber, CEO of HRI, points out, “Getting there requires the support of leadership–and there are a few common concerns that need addressing.” Leaders are often focused on Costs, Immediate Benefit, and Employee Utilization. It’s up to you to deliver on these key points.

Address the issues of cost by reminding leadership how little (if anything) creative benefits cost the organization. It might also help to frame benefits in terms of investments–not costs–in new employee acquisition and retention. And educate your employees. Actively promoting offerings in your recruiting strategy. Use open enrollment to re-educate employees. Add FAQs and educational content to the employee self-service portals in your HRMS.

About the Author: Kyle Lagunas is the HR Analyst at Software Advice. Kyle reports on trends, technology, and best practices in human resources and recruiting.

Responsibilities:
 Sales and marketing in the Maryland, VA, and Washington DC area
 Community outreach through traditional networking and through social media outlets
 Presentation of plan options and rate comparisons
 Assisting clients through the application process
 Communications to include explanation of benefits
 Tracking of policies in progress
 Lead generation and prospect management
 Additional marketing projects and responsibilities as assigned

Reilly Benefits is a small insurance and employee benefits consulting agency, located in Southern Anne Arundel County, Maryland. The firm has an energetic and enjoyable company culture. We’re looking for a member who wishes to be part of a close working group, someone who will contribute thoughts and ideas as a means to strengthen the team. The position offers opportunity for advancement.

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Testimonials

'The commitment Reilly Benefits makes to our company to ensure our benefits and claims are handled promptly and correctly goes beyond that of any agency I have seen in my 20 years of working with insurance brokers.'

Karen Siebert, CFOGreat Mills Trading Post

'The commitment Reilly Benefits makes to our company to ensure our benefits and claims are handled promptly and correctly goes beyond that of any agency I have seen in my 20 years of working with insurance brokers.'

Karen Siebert, CFOGreat Mills Trading Post

'Our experience with Reilly Benefits has been very positive. The courteous and friendly staff has taken care of our every need. Their knowledge and dedication have afforded us the opportunity to thoroughly explain the benefits and importance of insurance coverage to our employees. I would highly recommend this organization to any individual or business for all types of insurance or tax planning.'

Dottie Wyatt, ControllerAtlantic Cycle & Power

'Our experience with Reilly Benefits has been very positive. The courteous and friendly staff has taken care of our every need. Their knowledge and dedication have afforded us the opportunity to thoroughly explain the benefits and importance of insurance coverage to our employees. I would highly recommend this organization to any individual or business for all types of insurance or tax planning.'

Dottie Wyatt, ControllerAtlantic Cycle & Power

'We rely on the recommendations of Reilly Benefits to provide plan options for our employees in a way that controls our costs and we feel great relief knowing that they keep us abreast of health care legislation and other issues that affect the managemnent of our plans.'

Regina Anderson Vice President Dennis Anderson Construction

Benchmarks

Reilly Benefits, Inc. works with employers in a wide variety of industries. This allows us to understand the uniqueness of specific benchmarks within certain industries and among different market sizes.

Our ability to help employers compare and contrast a benefit plan to these benchmarks provides our clients an advantage in the ultimate goal to attract and retain quality employees.